Huamao Ye1, Xiang Feng2, Yang Wang3, Rui Chen4, Chao Zhang5, Wei Zhang6, Fei Guo7, Zeyu Wang8, Yu Fang9, Zhenjie Wu10, Qing Yang11, Bo Yang12, Chen Lü13, Linhui Wang14. 1. Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China. Electronic address: changhaimiwai@qq.com. 2. Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China. Electronic address: 13621951368@163.com. 3. Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China. Electronic address: oceansayhello@126.com. 4. Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China. Electronic address: drchenrui@foxmail.com. 5. Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China. Electronic address: tonyzhangchanghai@163.com. 6. Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China. Electronic address: weizhangchanghai@163.com. 7. Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China. Electronic address: 172715957@qq.com. 8. Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China. Electronic address: zeyuwangchanghai@163.com. 9. Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China. Electronic address: 13916943129@163.com. 10. Department of Urology, Shanghai Changzheng Hospital, The Second Military Medical University, PR China. Electronic address: wuzhenjie17@163.com. 11. Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China. Electronic address: qingyangchanghai@163.com. 12. Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China. Electronic address: boyangchanghai@163.com. 13. Department of Urology, Shanghai East Hospital Affiliated to Shanghai Tongji University, PR China; Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, PR China. Electronic address: chenlouie@live.com. 14. Department of Urology, Shanghai Changzheng Hospital, The Second Military Medical University, PR China. Electronic address: wanglinhuicz@163.com.
Abstract
BACKGROUND: /Objective: Currently there are few report of oncologic outcomes following robotic-assisted radical nephroureterectomy (RRNU) based on long-term follow-up. To evaluate the therapeutic effect of RRNU for upper tract urothelial carcinoma (UTUC), a technique of single-docking RRNU was described and its oncological outcomes was evaluated. PATIENTS AND METHODS: The data of 29 patients underwent RRNU for UTUC of Ta-T3 from July 2013 to June 2016 was analyzed. The data of 131 patients of UTUC underwent laparoscopic radical nephroureterectomy (LRNU) over the same period was analyzed as control. Kaplan-Meier analysis and Cox regression were used for prognosis evaluation. RESULTS: The median follow-up time was 40.5 and 40.4 months in RRNU cohort and LRNU cohort. No difference in 5-year intravesical recurrence-free survival (IVRFS) (88.0% vs. 85.5%, p = 0.611) or distant metastasis-free survival (93.1% vs.96.7%, p = 0.323) between RRNU cohort and LRNU cohort. The 5-year retroperitoneal recurrence-free survival and cancer-specific survival (CS) were lower in RRNU cohort than in LRNU cohort (77.3% vs. 87.7%, and 71.2% v.s. 84.7%, respectively). CONCLUSION: The single-docking RRNU is an effective treatment for UTUC, avoiding the re-docking of patient-side cart or the intraoperative reposition of patient, and bringing equivalent 5-year IVRFS compared to LRNU. However, the lower 5-year retroperitoneal recurrence-free survival and CS in RRNU cohort warned the concern of higher chance of local tumor spillage during RRNU. The noninferiority of RRNU to LRNU still needed the confirmation of large sample sized, prospective randomized controlled study.
BACKGROUND: /Objective: Currently there are few report of oncologic outcomes following robotic-assisted radical nephroureterectomy (RRNU) based on long-term follow-up. To evaluate the therapeutic effect of RRNU for upper tract urothelial carcinoma (UTUC), a technique of single-docking RRNU was described and its oncological outcomes was evaluated. PATIENTS AND METHODS: The data of 29 patients underwent RRNU for UTUC of Ta-T3 from July 2013 to June 2016 was analyzed. The data of 131 patients of UTUC underwent laparoscopic radical nephroureterectomy (LRNU) over the same period was analyzed as control. Kaplan-Meier analysis and Cox regression were used for prognosis evaluation. RESULTS: The median follow-up time was 40.5 and 40.4 months in RRNU cohort and LRNU cohort. No difference in 5-year intravesical recurrence-free survival (IVRFS) (88.0% vs. 85.5%, p = 0.611) or distant metastasis-free survival (93.1% vs.96.7%, p = 0.323) between RRNU cohort and LRNU cohort. The 5-year retroperitoneal recurrence-free survival and cancer-specific survival (CS) were lower in RRNU cohort than in LRNU cohort (77.3% vs. 87.7%, and 71.2% v.s. 84.7%, respectively). CONCLUSION: The single-docking RRNU is an effective treatment for UTUC, avoiding the re-docking of patient-side cart or the intraoperative reposition of patient, and bringing equivalent 5-year IVRFS compared to LRNU. However, the lower 5-year retroperitoneal recurrence-free survival and CS in RRNU cohort warned the concern of higher chance of local tumor spillage during RRNU. The noninferiority of RRNU to LRNU still needed the confirmation of large sample sized, prospective randomized controlled study.